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To the Editor: Dr Bruce and colleagues¹ reported that a community-based intervention reduced suicidal ideation and depression severity among a heterogeneous sample of older depressed patients. We believe that such studies are critical first steps in establishing the effectiveness of multidimensional interventions for depression in primary care settings. I am concerned, however, that such management programs may not be sustainable given current economic realities of primary care practice, especially when combined with the prevalence of clinically significant depression among older patients in primary care settings.

To illustrate, using the author's data of a 15.1% prevalence of clinical depression and an average of 1060 patients aged 60 years or older in each practice, any given practice might expect to find 160 geriatric patients with clinically significant depression. Assuming the acute treatment phase for depression is 4 months, and each identified patient required 6 visits, I estimate a reimbursement, based on the . . . [Full Text of this Article]

Christopher C. Colenda, MD, MPH
Colenda@medicine.tamu.edu
College of Medicine
Texas A&M University System Health Science Center
College Station

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